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Research & Commentary: Randomized Trial Finds E-Cigarettes Are More Effective Smoking Cessation Tool than Nicotine Replacement Therapy

February 11, 2019

New study finds electronic cigarettes and vaping devices to be "twice as effective as nicotine replacement at helping smokers quit."

A new study published in The New England Journal of Medicine finds the use of electronic cigarettes and vaping devices to be “twice as effective as nicotine replacement at helping smokers quit.”

In a “two group, pragmatic, multi-center, individually randomized, controlled trial,” researchers analyzed 886 randomized participants to examine the effects of e-cigarettes and nicotine replacement therapy (NRT) on smoking cessation. The participants, who were mostly “middle aged smokers,” were broken into an NRT group and an e-cigarette group. More than 78 percent completed the 52-week follow up conducted by the researchers.

More than100 participants reported abstinence during the 52-week follow up. Researchers found “80% … were using e-cigarettes at 52 weeks in the e-cigarette group and 9% were using” NRT products in the NRT group. Overall, the researchers concluded a higher abstinence rate in the group of e-cigarette users, with 18.0 percent. Participants in the NRT group reported a 9.9 percent one-year abstinence rate. E-cigarettes provided “greater satisfaction and were rated as more helpful to refrain from smoking” than NRT products.

In terms of smoking-related health issues, researchers found that “among participants who reported cough or phlegm at baseline, significantly more were symptom-free at the 52-week follow up in the e-cigarette group” compared to the NRT group. The researchers did run “an exploratory analysis that controlled for abstinence status at 52 weeks” and found no difference in results.

These latest findings provide more valuable information on the public health role that e-cigarettes and vaping devices provide for the 38 million cigarette smokers in the United States. Research increasingly indicates that the many tobacco products available to consumers today exist on a continuum of harm, with combustible cigarettes the most harmful.

In the past twenty years, researchers have examined the role of tobacco harm reduction products—including smokeless tobacco and snus, e-cigarettes and NRT products—and their role in helping smokers quit combustible cigarettes. Dr. Brad Rodu, a senior fellow at The Heartland Institute, has conducted extensive analyses on men in Sweden, who have the highest rate of smokeless tobacco use in Europe, and reports they also “have the lowest rates of lung cancer and other smoking-related disease in Europe.” It important to note that Swedish snus, a Swedish moist snuff tobacco product, is banned in all European Union countries except Sweden.

Other findings provide further evidence to the efficacy of e-cigarettes. Numerous leading public health groups have extensively studied these products and find them to be significantly less harmful than combustible cigarettes. Public Health England’s landmark report found e-cigarette use to be “95% less harmful” than combustible cigarettes. The Royal College of Physicians estimates e-cigarette use “unlikely to exceed 5% of the harm from smoking tobacco.” The National Academies of Sciences, Engineering, and Medicine found switching from combustible cigarettes to e-cigarettes “results in reduced short-term adverse health outcomes in several organ systems,” and the American Cancer Society has noted that “the exclusive use of e-cigarettes is preferable to continuing to smoke combustible cigarettes.”

Even more comforting to state lawmakers are the positive effects THR products can provide by reduction of health care costs associated with combustible cigarettes. One analysis found states would have saved $48 billion in Medicaid spending in 2012 if all then-currently smoking Medicaid recipients switched to e-cigarettes. Analysis on a smaller percentage of Medicaid recipients switching to e-cigarettes found that if one percent of the population switched to e-cigarettes, estimated Medicaid savings would “be approximately $2.8 billion per 1 percent of enrollees” over the next 25 years.

Policymakers should embrace evidence to the efficacy of THR products and provide a framework that moves to educate the public. Furthermore, policies and regulations aimed at THR products should reflect the relative harm of the products.

The following articles provide more information about tobacco harm reduction.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
https://www.heartland.org/publications-resources/publications/vaping-e-cigarettes-and-public-policy-toward-alternatives-to-smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Podcast Series: Voices of Vapers
https://www.heartland.org/multimedia/podcasts?fromDate=&toDate=&q=voices+of+vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

Research & Commentary: Study Finds E-Cigarettes Would Prevent 6.6 Million Premature Deaths
https://www.heartland.org/publications-resources/publications/research--commentary-study-finds-e-cigarettes-would-prevent-66-million-premature-deaths
Heartland Institute State Government Relations Manager Lindsey Stroud examines an October 2017 Tobacco Control study that found electronic nicotine delivery systems (ENDS) might help extend life for millions of people. The authors of the study found there was an estimated 6.6 million fewer deaths and more than 86 million fewer-life-years lost over a ten year period because of ENDS products. Stroud concludes the use of ENDS could also help improve the budgets of numerous state programs, including Medicaid.

Research & Commentary: Public Health Officials Urge Use of Electronic Nicotine Delivery Systems
https://www.heartland.org/publications-resources/publications/public-health-officials-urge-use-of-electronic-nicotine-delivery-systems
Heartland Institute State Government Relations Manager Lindsey Stroud notes the importance of NHS Health Scotland’s joint statement encouraging the use of electronic nicotine delivery systems (ENDS) as an alternative to tobacco products. NHS Health Scotland, Public Health England, and other groups have found ENDS are 95 percent less harmful than tobacco cigarettes.

Research & Commentary: Qualitative Study on E-cigarettes Shows More Evidence of Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/qualitative-study-on-e-cigarettes-shows-more-evidence-of-tobacco-harm-reduction?source=policybot
Heartland Institute State Government Relations Manager Lindsey Stroud examines a study, published in The International Journal of Environmental Research and Public Health in June 2016, that provides additional evidence showing e-cigarettes and vaporized nicotine products (VNPs) are an effective tobacco harm-reduction tool.

E-Cigarette Primer for State and Local Lawmakers
http://heartland.org/policy-documents/e-cigarette-primer-state-and-local-lawmakers
Dr. Joel Nitzkin, a senior fellow in tobacco policy for the R Street Institute, provides evidence e-cigarettes work as a tobacco harm reduction modality and reviews the arguments against them. He closes with recommendations for actions state and local lawmakers should and should not consider regarding tobacco harm reduction and e-cigarettes.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus, host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Lindsey Stroud, Heartland’s state government relations manager at lstroud@heartland.org or 757/354-8170.